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New Report Offers Groundbreaking Look at Lives of Transgender People in Rural America

Limited Resources and Service Providers in Rural Areas Amplify the Impact of Experiences of Discrimination or Acceptance of Transgender People

(November 19, 2019) Des Moines, IAStereotypes and pop culture portrayals often overlook the diversity of rural America, framing rural regions as made up predominantly of white, politically conservative people who are hostile to LGBT people. But millions of LGBT people, including transgender people, live in rural communities—and while some struggle, others thrive. Today, the Movement Advancement Project (MAP) released a new report, Where We Call Home: Transgender People in Rural America,  which includes original analysis of the unique challenges and opportunities for transgender people in rural America. As the third publication in the Where We Call Home series (released in partnership with the Equality Federation, the National Black Justice Coalition, and the National Center for Lesbian Rights) this report details how the structural differences of rural life amplify acceptance of or discrimination against transgender people. 

Today’s report release coincides with a Congressional briefing on the unique experiences of LGBT people in rural America, cosponsored by the National Center for Lesbian Rights and in cooperation with the Congressional LGBT Equality Caucus and Representative Angie Craig of Minnesota. The briefing will also discuss how Congress can ensure that all people in rural America, including LGBT people, can have an equal opportunity to support their families and contribute to their communities and the country.

Despite a lack of visibility, transgender people have always been a part of the social fabric of rural America,” said Ineke Mushovic, executive director of the Movement Advancement Project. “But because there are fewer employment and healthcare options for rural transgender people, discrimination can effectively prevent them from getting a job or medical care at all. And these challenges are even starker for transgender people of color in rural communities. This is why it is vital for states and the federal government to update nondiscrimination laws to include and protect transgender people, to modernize processes for updating identity documents, and to overturn HIV criminalization and religious exemption laws that further harm and limit transgender people’s access to health care and other needed services." 
This report, which includes original analysis of the 2015 U.S. Transgender Survey (USTS), offers extensive new findings on transgender people in rural communities. Although experiences of discrimination are typically as common in rural areas as in urban areas, structural challenges in rural areas, such as fewer employment or healthcare options, means the impact of discrimination on the lives of rural transgender people may be particularly profound. 

As discussed in the report findings: 

Roughly one in six (16%) transgender people live in rural areas—the same percentage of the non-transgender population which lives in rural areas—according to a recent analysis by the Williams Institute of nationally representative federally-funded data. 

Rural transgender people are more than two times more likely—and rural transgender people of color are nearly four times more likely—as the general rural population to be unemployed and living in poverty, despite being more likely than their rural neighbors to have a college degree. 

Rural transgender people are two times more likely (18%)—and rural transgender people of color are over three times more likely (30%)—to be uninsured than the rural U.S. population (9%) 

For rural transgender adults who had insurance and sought coverage for transition-related surgery, 69% were denied coverage, compared to 55% of all insured transgender adults.  

Rural transgender people travel remarkable distances to see their healthcare providers. Nine percent (9%) of all transgender people travel 75 miles or more to see their transgender-related healthcare provider, but in rural areas, 27% of transgender people and 33% of transgender people of color travel 75 miles or more.  

Rural transgender people are six times more likely (1.7%) and rural transgender people of color are 20 times more likely (6%) than the general U.S. population (0.3%) to be HIV+.  

Click here to view this as an infographic.

“Black transgender and gender non-conforming people face some of the highest levels of discrimination of all transgender people,” said David Johns, executive director of the National Black Justice Coalition. We know, based on the Where We Call Home: LGBT People of Color in Rural America report, that these experiences are compounded by the unique challenges of rural communities—especially because rural states are home to some of the worst LGBTQ policy climates and some of the highest populations of people of color, making it easy to maintain racial discrimination in rural communities. Too often people forget that Black transgender and gender non-conforming people call rural America home, too, and this erasure can result in gaps in services and supports. There's no reason why rural transgender people of color should be nearly four times more likely as the rural population to be unemployed and living in poverty, despite being more likely than their rural neighbors to have a college degree. The National Black Justice Coalition is proud to contribute to a report highlighting these important intersectional realities.” 

Where We Call Home: Transgender People in Rural America concludes with critical recommendations: 

Because transgender people in rural communities face significant obstacles to accessing and receiving care, improving access to transgender-inclusive health care that is both affordable and culturally competent is vital to adequately serving transgender patients.  

States and the federal government should rescind and block harmful religious exemption laws that may allow service providers and employers to legally discriminate against transgender people.  

State officials and lawmakers should adopt laws to ensure transgender and non-binary people can update their identity documents, including driver’s licenses and birth certificates, to match their name and gender identity.  

Passing and enforcing transgender-inclusive nondiscrimination laws, as well as repealing discriminatory laws that disproportionately harm transgender people (e.g., HIV criminalization laws), will help to improve the quality of life for transgender people in rural America.   

“Transgender people in rural areas face some of the most severe isolation and discrimination in our country, and yet their voices have for too long gone almost entirely unheard,” said Shannon Minter, legal director of the National Center for Lesbian Rights. “This breakthrough report shines a much-needed light on both their resilience and their struggles—and provides a roadmap for a policy agenda to build long-term change.” 

“Our members in rural areas are fighting for access to transgender-inclusive healthcare, affordable updated identity documents, nondiscrimination protections, and relief from HIV criminalization laws and religious exemptions,” said Rebecca Isaacs, executive director of Equality Federation. “The current policy landscape is failing our transgender neighbors in rural communities and we need more research and data collected to know the full scope of the harm done. What we do know is that transgender people have a harder time getting documents to match their gender identity leading to increased discrimination. Finding quality medical care nearby is another major challenge transgender individuals face. This important report is a blueprint for reversing the harm done to transgender people living in rural areas.” 

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About MAP: MAP's mission is to provide independent and rigorous research, insight, and communications that help speed equality and opportunity for all. MAP works to ensure that all people have a fair chance to pursue health and happiness, earn a living, take care of the ones they love, be safe in their communities, and participate in civic life.  

About NBJC: The National Black Justice Coalition (NBJC) NBJC is a civil rights organization dedicated to the empowerment of Black lesbian, gay, bisexual, transgender, queer and same gender loving (LGBTQ/SGL) people, including people living with HIV/AIDS. NBJC’s mission is to end racism, homophobia, and LGBTQ/SGL bias and stigma. As America’s leading national Black LGBTQ/SGL civil rights organization focused on federal public policy and grassroots organizing, NBJC has accepted the charge to lead Black families in strengthening the bonds and bridging the gaps between the movements for racial justice and LGBTQ/SGL equality. 

About NCLR: The National Center for Lesbian Rights (NCLR) was the first national LGBTQ legal organization founded by women and brings a fierce, longstanding commitment to racial and economic justice and our community’s most vulnerable. Since 1977, NCLR has been at the forefront of advancing the civil and human rights of our full LGBTQ community and their families through impact litigation, public policy, and public education. Decades ago, NCLR led the way by establishing the first LGBTQ Immigration Project, Transgender Rights Project, Youth Project, Elder Law Project, and began working to end conversion therapy through what is now the Born Perfect campaign. NCLR also hosts regular Rural Pride convenings around the country, which provides a forum to focus on the unique needs of the rural LGBTQ community.  

About the Equality Federation: Equality Federation is the movement builder and strategic partner to state-based organizations advocating for LGBTQ people. From Equality Florida to Freedom Oklahoma to Basic Rights Oregon, we amplify the power of the state-based LGBTQ movement. 

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Sexual Orientation Policy Tally

The term “sexual orientation” is loosely defined as a person’s pattern of romantic or sexual attraction to people of the opposite sex or gender, the same sex or gender, or more than one sex or gender. Laws that explicitly mention sexual orientation primarily protect or harm lesbian, gay, and bisexual people. That said, transgender people who are lesbian, gay or bisexual can be affected by laws that explicitly mention sexual orientation.

Gender Identity Policy Tally

“Gender identity” is a person’s deeply-felt inner sense of being male, female, or something else or in-between. “Gender expression” refers to a person’s characteristics and behaviors such as appearance, dress, mannerisms and speech patterns that can be described as masculine, feminine, or something else. Gender identity and expression are independent of sexual orientation, and transgender people may identify as heterosexual, lesbian, gay or bisexual. Laws that explicitly mention “gender identity” or “gender identity and expression” primarily protect or harm transgender people. These laws also can apply to people who are not transgender, but whose sense of gender or manner of dress does not adhere to gender stereotypes.

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